Republic of the Philippines..

)
In the City of Davao………..)S.S.
x---------------------------------x

AFFIDAVIT OF LOSS

I, SGT. JOSE EDWIN M. HANAYAN, of legal age, married, Filipino,

and a resident of Purok Dahlia Mangga, Visayan Village, Tagum City ,
Philippines, after being duly sworn in accordance with law, hereby depose and
say THAT :

1. I am the herein affiant;

2. I am a holder of Landbank of the Philippines ATM Card ;

3. The above-mentioned ATM Card was placed inside my wallet ;

4. However, recently, I discovered that the said ATM Card was no

longer in my above-mentioned wallet;

5. To this day and despite repeated search, I have not found the said
Landbank of the Philippines ATM Card , hence, considered lost for all
legal intents and purposes;

6. I am executing this affidavit in order to attest to the truth of the

foregoing facts and for whatever purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 22 nd

day of March 2016, in Davao City, Philippines.

SGT. JOSE EDWIN M. HANAYAN

Affiant

SUBSCRIBED AND SWORN to before me this 22nd day of

March 2016, in Davao City, Philippines. Affiant exhibited to me hi AFP I.D. No.
A15-E085669 valid until 13-11-2017 issued at Davao City.

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